Project Manager Home Health
Resume:
Guinevere Blodgett, RN, BSN
Denver, COLORADO
Dedicated quality focused nurse manager and director with experience
in acute care and psychiatric hospitals, managed care, and home health
settings. Client and goal-oriented team leader with a commitment to
continuous quality improvement, patient safety, staff development, and
process improvement. Proven ability to prioritize, analyze, plan,
manage and motivate within a healthcare environment, with advanced
skills in:
. Process Improvement
. Communication
. Team Development
. Federal and Colorado State Regulations
. Staff Development
. Quality Management
. Program Development
. Customer Service
. Accreditation Activities
. Project Management
. Policies and Procedures
. Utilization Review
HIGHLIGHTS / PROFESSIONAL ACCOMPLISHMENTS
. Proven leader with extensive experience in operations/health
care management, with a proven track record of delivering
results.
. Responsible for process improvement, financial, and operational
management in clinical departments.
. Development of staff appreciation programs to enhance job
satisfaction.
. Successful accreditation in clinical areas of responsibility.
. Collaborated with other leaders to improve operational,
utilization, and case management processes and systems in order
to maximize the quality of care in key strategic patient care
areas.
. Redesigned the workflow of an existing outpatient department to
maximize and expedite the processing of patients.
. Developed an initiative to increase patients' satisfaction with
care.
. Worked directly with the CEO and department heads to
strategically market and build hospital services.
. Worked with community leaders to improve access to care.
. Project management and process improvement.
WORK EXPERIENCE
January 2011 - Current
Colorado Department of Health Care Policy and Financing
Policy Specialist Home Health, Private Duty Nursing & Hospice
Subject matter expert for Medicaid for the home health, private duty
nursing and hospice benefits. As staff authority, this position is
responsible for developing and managing benefit policies for home health,
private duty nursing, and hospice, a critical class of services and
programs that are necessary to achieve the Department's mission and goals
of improving access to cost-effective, quality health care services that
result in positive health outcomes for Coloradans. The position is required
to maintain a unique clinical and administrative level of knowledge and
expertise in home health, private duty nursing, and hospice, to design,
analyze, and amend benefit and program policies. Managing these benefits
requires the position to research and recommend best practices; identify
and address benefit or policy gaps; solicit and respond to provider,
client, and stakeholder participation in benefit policy development; and
assess current and future benefit policies. The position provides technical
assistance and works with other Department staff to develop program rules,
fiscal notes, proposed legislation and best practices. This position also
serves as a clinical resource and educates other Department staff about the
home health, private duty nursing, and hospice benefits.
May 2010 - November 2010
Bayada Nurses
Clinical Specialist
This position was responsible for administrative clinical oversight
for a home health agency. This role supervised registered and licensed
practical nurses and certified nursing assistance. This agency was a
Class A skilled home care agency in good standing with the federal and
state agencies responsible for oversight. Clinical manager completed
quality review on staff documentations and ensured that the conditions
of participation were met. This role was also responsible for
orientations, disciplinary actions and remediation activities for
staff that reported into this position. During this employment period,
worked with company leadership to create efficiencies within the
office and throughout clinical practice.
October 2009 - May 2010
Health One Home Health Care; Denver, Colorado
Director of Nursing/Administrator
Hired as Director of Nursing for a start-up home health company and
worked to develop policies, procedures including a business plan and
administrative polices. This agency successfully completed the
Community Health Accreditation Program and initial licensure with no
deficiencies. However, the owners decided that they could not continue
with this endeavor, so the agency closed prior to official opening.
This company closed in May 2010.
May 2008 - August 2009
Colorado Access; Denver, Colorado
Behavioral Health Quality Coordinator
Responsible for all regulatory activity regarding Access Behavioral Care's
Medicaid line of business for the Denver population, requiring knowledge of
state and federal regulatory standards and practices. Responsible for
access to care information and presentation of quality information to the
client population. Liaison between state officials and Colorado Access.
Developed and interpreted reporting produced for the behavioral line of
business. Acted as Project Manager to develop a process for Inter Rater
Reliability and Peer Review Process. Led a process to improve timeliness
of outpatient psychiatry visits. Also worked with CHIP and Medicare lines
of business.
July 2007 - May 2008
North Valley Hospital; Thornton, Colorado
Director of Psychiatric Services
Acted as Administrator and Director for two psychiatric units
(geriatric and adult) overseeing 40+ staff, including Nurses, nurse
aides, Mental Health Workers, Case Managers, Social Workers,
Counselors, and other auxiliary staff. Wrote and implemented a policy
for care provided to psychiatric patients. Knowledgeable in Colorado
Alcohol and Drug Abuse Division (ADAD) regulations policy, Joint
Commission, and the Centers for Medicare and Medicaid Services
standards of providing care to psychiatric patient population. Wrote
and implemented ADAD criteria and Joint Commission action plans as
needed. Provided budgeting, hiring and maintenance of qualified,
quality staff for both units. Updated operation and administrative
policies and contracts with providers and staff contracted with the
unit. Provided staffing and scheduling. Liaison between psychiatric
staff and executive staff. Provided ongoing education to staff.
Responsible for quality audits, compliance and staffing. Also acted as
interim Long-Term Acute Care Director in providing administrative
support for that unit.
February 2004 - July 2007
Great-West Life & Annuity; Greenwood Village, Colorado
Manager, Quality Care Management - Specialty Markets - September 2006
to July 2007
Primary duty was to act as project manager and accountable party to
develop business workflows to meet the needs of Great West's Third
Party Administrators (TPA). Oversaw development of programs and
processes to deliver customer-centric utilization management TPAs.
Managed regional staff, with an emphasis on ensuring timely and
correct handling of TPA and customer utilization management requests
and disease management/wellness needs. Implemented offsite specialty
unit to manage customer needs and meet expectations. Responsible for
meeting compliance and accreditation criteria. Developed and provided
quality analysis and unit reporting to senior management. Participated
in implementation of new TPA business. Worked with the Specialty
Markets team to continually refine the medical outreach product and
develop new business processes, including a case management program
for Great-West's TPA business partners. Maintained current working
knowledge of industry-based patient safety initiatives, including NCQA
and URAC and assisted with accreditation activities and policy
creation to meet accreditation compliance. Collaborated with Medical
Directors to develop and update Preventive Care Guidelines for the
member website and oversight for the disease management program.
Quality of Care Manager - February 2004 to September 2006
Received, reviewed, and appropriately investigated and resolved
potential quality of care issues/adverse events and customer
complaints. Coordinated quality of care process with regions and
corporate areas for timely review of quality of care concerns.
Maintained Access database for reporting. Accurately documented
issues in database and ensured incorporation into credentialing
process to provide forum for peer review. Monitored database for
accurate quality assurance reporting. Maintained current working
knowledge of industry-based patient safety initiatives, including NCQA
and URAC. Collaborated with Medical Directors to develop and update
Preventive Care Guidelines for the member website. Assisted with
delegation oversight for a disease management program. Provided
quarterly reports to Regional Quality Management and for Board
Meetings. Oversaw development of reports on quality of care activity
for monthly credentialing meetings. Provided education to regional
offices regarding referral process for quality of care concerns, as
needed. Assisted with accreditation activities and policy creation to
meet accreditation compliance. Worked with multiple areas to develop
performance improvement project to refine and bring appeals process
into expected timeframe. Acted as project manager to coordinate
efforts and documents required for this process.
March 2001 - February 2004
Sloans Lake Managed Care; Greenwood Village, Colorado
Quality Coordinator/Case Management Nurse
Promoted to Quality Coordinator in June 2002. Responsibilities
included oversight of Utilization Management programs to promote
quality assurance, investigation of quality of care concerns, and
patient complaints. Managed subordinates to ensure processes and
policies were followed. Oversight and management of UM and CM
policies and procedures. Staff education of quality programs and URAC
standards. Coordinated quality piece for URAC accreditation reviews.
Investigated medical treatments considered experimental and
investigational. Under direction of the Chief Medical Officer,
created an internal approval criteria for nurse-level reviewers for
use in the UM and CM programs. Identified quality improvement
opportunities and presented proposals and updates to applicable
committees. Acted as project manager in the development of the
telephonic and field case management process to include education and
hiring of staff.
Managed 25 to 35 files with complex medical issues and evaluated
treatment requests for medical necessity. Coordinated treatment,
communication and referrals between patients, providers, and
adjusters. Knowledge of insurance and state guidelines to ensure
accurate and timely care. Other duties included providing customer
service for medical professionals, insurance adjusters, and injured
parties that called into the company.
January 2000 - March 2001
Swedish Medical Center; Englewood, Colorado
Charge Nurse/Educator - Transitional Care Unit
Experience included MDS and medical record audits, provided new and
current employee orientation and education on hospital policies and
equipment, as well as instruction in the on-line hospital
documentation and charting system. Also participated in documentation
committees and acted as a nursing consultant and co-programmer for the
hospital's software upgrades. As night charge nurse, was responsible
for patient and family care, problem solving and communication with
staff and management, training and education of staff, as well as
employee evaluations and reviews. Responsible for staffing unit and
conflict resolution. Worked closely with care managers and other
charge nurses to ensure standards of care issued by accreditation
groups were met. Acted as consultant in the development of
HealthOne's computerized charting system and training program.
January 1999 - October 1999
Williamsburg Community Home Health; Williamsburg, Virginia
Registered Nurse/Case Manager
Provided home health care to psychiatric patients in the community and
provided case management and outpatient coordination of care for these
patients. Provided home care to Pediatric Oncological, Obstetrical,
and Medical/Surgical patients. Care included medication management,
intravenous therapy, chemotherapy, wound care, case management,
diabetic education, prenatal and postnatal care, hospice care, and
associated teaching. Also required ability to work within and
understand insurance, Medicare, and Medicaid guidelines, as well as
provide timely and thorough documentation. Open communication with
patients, families, doctors, and other members of their health care
team was an essential component, as was the ability to work
independently and autonomously.
OTHER PROFESSIONAL EXPERIENCE
Oct 1999 - July 2005
Professional Staffing Agency; Denver, Colorado
Per Diem Registered Nurse
Provided clinical nursing skills and functioned in a variety of care
areas, including acute and sub acute units. Required flexibility and a
broad knowledge of various facilities' policies and procedures. The
ability to adapt to new situations, high stress situations and time
management was essential in this position.
EDUCATION
1998 Riverside College; Newport News, VA Nursing
. GPA 3.86
1997 Thomas Nelson College; Hampton, VA Science
. GPA 4.0. Was awarded honor credits in Humanities, Psychology,
Anatomy and Physiology and Biology
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